Simulated Patient Brief — CAMERON (ACS)
Location: Accident and Emergency. History only — no examination. Answer in the negative to any specific question not covered below.
- Name
- Cameron
- Age
- 62 years
- Opening statement
- “I’ve got this severe chest pain — my daughter insisted on bringing me in.”
You have attended your local A&E with chest pain. Your daughter insisted on driving you there and she is now outside looking for a space to park. You can converse in full sentences, but during the consult appear to be in moderate discomfort.
Severe chest pain started 2 hours ago while you were reading at home. It began in the upper abdominal region and is now behind the sternum. It felt like severe indigestion and worsened within minutes to an 8/10 dull, heavy pain — “as though someone is sitting on my chest.” The pain has been constant for 2 hours. Nothing has provided relief. You took Gaviscon thinking it was indigestion, and paracetamol, with no benefit.
You feel nauseous and have vomited a small volume of normal stomach contents. You are sweating profusely and feel short of breath. Your daughter said you looked clammy in the car. Standing or moving around makes the pain and breathlessness worse. You have never had pain like this and have no history of chest pains. You get occasional milder reflux that responds to antacids; this does not feel like that.
Response to questions
- Open questions (e.g. “tell me more about the pain”): describe site, onset, character, severity and associated features as above. Be open about the symptoms.
- Closed questions only: radiation — if asked specifically, the pain radiates to the jaw and down the left arm. Answer other specifics not in the script in the negative.
Ideas: You initially thought it might be severe indigestion, but now you are worried it is something more serious.
Concerns: You are worried that you are about to die because the pain is so severe, and you are extremely worried.
Expectations: You want urgent help to relieve your symptoms and to understand what is happening.
- Never admitted to hospital with a medical or surgical issue
- Hypertension diagnosed 2 years ago
- Attends NHS screening / health checks; no concerns identified
- Saw GP 2 months ago with flu-like symptoms — self-limiting viral infection
- Allergy to Elastoplast
- Enalapril 5 mg once daily for blood pressure
- Over-the-counter Gaviscon occasionally for reflux
- Mother died at 78 from breast cancer
- Father alive, in his 80s — hypertension and severe angina since his 50s; bypass surgery years ago
- No siblings
You live alone in a bungalow. Retired NHS administrator. Generally sedentary but normal body weight. Cope with ADLs; takeaway 4–5 nights a week as you dislike cooking. One daughter lives nearby and helps if needed. Smoke 10 cigarettes/day (was 20; cut down 2 years ago at HTN diagnosis). Smoking since age 15. Drink 1–2 glasses of wine every evening. No recreational drugs. If smoking cessation is offered, say you have been considering it and might contact your GP, but today is not the day.
Systems review: reply in the negative to any other symptoms.